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Special pops Exam 3 > Osteoporosis > Flashcards

Osteoporosis Flashcards

(64 cards)

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1
Q

What patient population does osteoporosis mostly occur in?

A

Post menopausal women

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2
Q

Type of osteoporosis that occurs in post menopausal women?

A

Type 1

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3
Q

Type of osteoporosis that is age related

A

Type 2

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4
Q

Secondary osteoporosis

A

Type 3

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5
Q

What are the 4 types of osteoporosis?

A
  1. Type 1
  2. Type 2
  3. Type 3
  4. Primary idiopathic
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6
Q

What are 4 symptoms of osteoporosis?

A
  1. Fractures
  2. Pain
  3. Kyphosis
  4. Loss of height
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7
Q

What patient population experiences hip fractures more?

A

Men

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8
Q

How does osteoporosis impact vertebral fractures?

A

Increases vertebral fracture risk by 5 fold and hip fractures by 2 fold

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9
Q

What are the 9 risk factors of osteoporosis?

A
  1. Advancing age
  2. Menopause
  3. Early menopause
  4. Caucasian or Asian descent
  5. Family history
  6. Alcohol/ cigarette smoking
  7. Prolonged inactivity
  8. Small thin frame
  9. Nutritional
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10
Q

What are the two most predictive sites for a bone density assessment?

A
  1. Lumbar spine
  2. Proximal femur
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11
Q

What T score is considered normal?

A

Above or equal to -1

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12
Q

What T score shows osteopenia?

A

Between -1 and -2.5

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13
Q

What T score is indicative of osteoporosis?

A

-2.5 or lower

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14
Q

What score is indicative of severe or established osteoporosis?

A

-2.5 or lower plus a fracture

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15
Q

Each SD decrease in BMD is associated with a 2 fold ________________

A

Increase in fracture risk

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16
Q

What is the preferred site for assessing hip fracture risk?

A

Proximal femur

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17
Q

What part of the body is most useful for assessing a therapeutic response?

A

The lumbar spine

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18
Q

What other body parts can be used for diagnosis?

A

Forearm and heel

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19
Q

When should women get screened for osteoporosis?

A
  1. Age > 65
  2. Age < 65 if 10 year fracture risk is that of a 65 yo Caucasian woman without additional risk factors
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20
Q

When should men get screened for osteoporosis?

A

No recommendation

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21
Q

Who should have a BMD test? 6

A
  1. All women aged 65 or older; men over 70
  2. Women going through menopause and men 50-69 with one or more risk factors
  3. Adults with a fracture after age 50
  4. Post menopausal women d/c estrogen
  5. Anyone being considered for treatment
  6. Adults with a condition or taking meds associated with bone loss
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22
Q

When should vertebral imaging indications be used?

A
  1. For women 70 or older and men 80 and older
  2. Women 65-69 and men 75-79 with a T score -1.5 or below
  3. Post menopausal women 50-64 and men 50-69 with specific risk factors
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23
Q

What are 11 drugs that could increase fracture risk?

A
  1. Glucorticoids
  2. Aromatase inhibitors
  3. Gonadotropin releasing hormone agonists
  4. Immunosuppressants
  5. Anticonvulsants
  6. Cytokines drugs
  7. Long term heparin use
  8. Lithium
  9. Depo-provers
  10. TPNs
  11. Possible: PPIS + SSRIS
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24
Q

How much calcium should women >51 and men >71?

A

1200 mg/day

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25
How much calcium should men 50-70 take?
1000 mg/day
26
High calcium intake can lead to an increase in what?
MI risk
27
For patients <50 how much vitamin D should patients take?
400-800 IU/day
28
For patients 50 and older, how much vitamin D should they take?
800-1000 IU/day
29
For patients less than or equal to 70. How much vitamin D should they take?
600 IU/day
30
For patients 71 or older, how much vitamin D should be taken per day?
800 Units/day
31
Who are candidates for medications to treat osteoporosis?
Post menopausal women and men over **50** with one of the following: 1. A hip or vertebral fracture 2. Other fractures and low bone mass 3. T score <-2.5 4. Low bone mass and secondary causes associated with a high risk fracture 5. Low bone mass and 10 year probability of hip fracture 3% or greater or a 10 year probability of any osteoporosis related fracture 20% or greater
32
What are the 2 bone forming medications used to increase the rate of bone formation in the bone remodeling cycle?
1. PTH hormone and analogs 2. Sclerostin inhibitors
33
What are the 7 medications used to prevent/ treat osteoporosis?
1. Bisphosphonates 2. SERMs 3. Denosumab 4. Calcitonin-Salmon 5. Romosozumab 6. Teriparatide 7. Hormone therapy and estrogen therapy
34
What are the 3 bisphosphonates used for osteoporosis?
1. Alendronate 2. Risedronate 4. Ibandronate
35
What should bisphosphonates be taken with?
Calcium and vitamin D and with plain water
36
What patient population can use bisphosphonates?
Both men and women
37
Zoledronic acid (tx of osteoporosis)
RECLAST
38
What should you pretreat with for reclast?
Acetaminophen
39
When should a risk assessment be performed for bisphosphonates?
After the initial 3-5 year treatment period
40
Raloxifene
Evista
41
What are 3 SEs of evista?
1. Hot flashes 2. Leg cramps 3. Vaginal discharge
42
What are 2 concerns with the use of bisphosphonates?
1. DVT 2. increase risk of a fatal stroke
43
What should raloxifene be taken with?
Adequate calcium and vitamin D
44
What patient populations can use raloxifene?
Women who have conditions that prevent the use of bisphosphonates
45
What does Duavee treat?
Vasomotor symptoms and prevents osteoporosis in post menopausal women
46
What is the indication for calcitonin-salmon?
Treatment
47
What should calcitonin-salmon be taken with?
Adequate calcium and vitamin D
48
What medication relieves pain of recent spinal fractures and reduces the need for analgesics?
Calcitonin-salmon
49
For the use of estrogen to treat osteoporosis, what needs to happen first?
There must be another indication
50
Denosumab
Prolia
51
What is Denosumab used for?
To treat post menopausal women with osteoporosis at high risk of fracture (>/= 3%)
52
What drug needs to be in the REMS program?
Prolia
53
What are the 2 PTH drugs?
1. Teriparatide 2. Abaloparatide
54
Teriparatide
FORTEO
55
Abaloparatide
TYMLOS
56
What should Teriparatide not be used with?
Bisphosphonates
57
What 4 things are considered High risk of osteoporosis?
1. Men and women with previous osteoporotic fractures 2. Men and women with multiple risk factors for fracture 3. Men and women with extremely low BMD (-3 or below) 4. Those with treatment failures to osteoporosis therapies
58
What patient populations can use Teriparatide?
1. Post menopausal women with osteoporosis at high risk of fracture 2. Men with primary hypogonadism osteoporosis at high risk of fracture
59
Romosuzumab
Evenity
60
What drug class is romosuzumab?
Sclerostin inhibitor
61
What’s the BBW of romosuzumab?
MI, stroke, and cardiovascular death
62
What can be used as an add on for pain relief of recent spinal fractures?
Miacalcin
63
Osteoanabolic agents should be followed by what 2 medications?
1. Bisphosphonates 2, Denosumab
64
What drug is a RANK-L inhibitor?
Densosumab

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